It is widely recognized that colorectal cancer (CRC) is one of the most preventable cancers. If adenomatous polyps detected by screening were removed before they transformed into cancers, a decrease in new CRCs and in related mortality would follow. Unfortunately, cancer screening rates are low throughout Appalachia, including for Latino residents in PA. Further, Latinos are more likely to be diagnosed at later stage than Whites, have a lower survival rate and less access to quality treatment. Our long-term goal is to increase CRC screening uptake among Latinos in urban and rural central Pennsylvania (PA). Our central hypothesis is that a targeted CRC screening intervention can increase uptake over a non-targeted approach for this population. The specific objectives of the current proposal are to develop, implement and evaluate a targeted CRC screening intervention to increase CRC screening uptake. We will measure actual CRC uptake in both the control and intervention arm as a method to determinate completion rates. To prepare for my K01 application during my post-doc training, I led the design, implementation, and analysis of a CRC-related Latino study that provided preliminary data for theK01 work. In 04/09, utilizing the ACCN coalitions in PA, I conducted eight focus groups (FG) to identify barriers to CRC screenings among Latinos. We identified several substantial barriers to CRC screening for this population, including a significant barrier heretofore unmentioned in literature related to CRC screenings. Spanish-speaking patients want to have family members or close friends in the doctor office and health-related education classes. This barrier was reported across all groups and likely links to the desire for a strong social support that influences their CRC screening behavior. Another finding is that urban residents had some prior knowledge of risk factors associated with CRC screening while rural residents reported no prior knowledge and were unable to list any associated CRC risk factor. A high acceptability of the provider-recommended take-home fecal immunochemical test (FIT) for these Latinos was also reported. We exceeded our study recruitment goal. The same partnered Latino leaders are committed to the K01 proposed work. The K01 study design is a randomized, community-based, participatory design to determine completion of a provider-recommended, take-home FIT kit without (control) and with social support (intervention) among a sample of average-risk, urban and rural Appalachian Latino adults age 50 and older not currently adherent to national CRC screening guidelines (N=264).Each consented participant will attend a one-time, community- based CRC screening educational program offered at one of the eight study sites located in Central PA. The proposal is innovative because it combines provider-recommended FIT screening test with an education program and social support for Latinos in a randomized, community-based participatory research design. Further, it will provide preliminary data for evidence-based methods to increase CRC screening rates among Latinos throughout Appalachia, the focus of a future NIH NC1 R-series grant application.